Intellectual impairment and dentistry

Question 1

What are barriers to oral healthcare

Answer 1

user/carer
professional service providers
physical barriers
cultural issues

Question 2

What is having access to primary care beneficial

Answer 2

proximity
relationships may already be established
family may attend practice
longitudinal care 
equal opportunity to services

Question 3

How can we help them get to the surgery

Answer 3

preparation
social stories (autism)
hospital/health passport
pre visit
multiple visits with slow progress
lease with community disability nurse/team for help

Question 4

How should you arrange arrival of these patients

Answer 4

time appointment for u and px 
start of a session - not running late
give yourself time
best time of day for px
take px straight to surgery and limit time spent in waiting room

Question 5

How can we communicate verbally

Answer 5

speak clearly

ask to repeat info u don’t understand

ask qs that are yes or no

don’t lead px response

allow enough time to communicate

don’t interrupt or finish px sentences

repeat the q if they don’t understand

Question 6

What are adjuncts to communication

Answer 6

makaton
picture boards
letter boards
talking mats
draw
write

Question 7

How can we make the right atmosphere for px

Answer 7

non threatening environment
friendly
acclimatize - multiple visits
consider augmentative techniques - relaxation, music

Question 8

How should we do the first visit

Answer 8

what can u find out before
keep it simple
building trust and relationships
don’t expect too much

Question 9

What is useful for examination

Answer 9

access to mouth
bedi shield
open wide mouth rests
toothbrush
mirror
good light
head support but ask for consent

Question 10

When is clinical holding considered

Answer 10

if failure of other techniques

Question 11

When should clinical holding take place

Answer 11

if no capacity and it is deemed of benefit - px may present a safety risk to them self or others

if px consnets

unplanned emergency where px at significant risk

always record in notes and justify

Question 12

What are conditions to look out for in medical history

Answer 12

epilsepy
psychiatric conditions
congenital defects in other systems

Question 13

When treatment planning what do u want it to b e

Answer 13

indivudal
holistic
realistic

Question 14

What are risk factors for oral health

Answer 14

poor motor control
imbrication of teeth
lack of cleansing
pouching and limited food clearance
mouth breathing
medications
rewarding

Question 15

How can we provide tooth brushing advice

Answer 15

explain first
good time of day and night
wear gloves
stand behind person slightly to one side
keep brushing systematic
encourage px to do as much as possible

Question 16

What is self injurious behavior

Answer 16

self biting of hands arms lips and tongue

Question 17

What can self injurious behavior be linked to

Answer 17

CP
autism 
tourettes
lesch-nyan syndrome
profound neurodisaiblity
exaggerated or abnormal oral reflex, habit, pain and/or frustration

Question 18

What is treatment strategies for self injurious behavior

Answer 18

1. symptomatic relief
2. reassurance for px, parents and carers with monitoring of the situation
3. distraction when SIB observed
4. pharmacological tx
5. behavioral psychology such as positive reinforcement
6. construction of oral appliances
7. extraction of specific anterior teeth although this may transfer the SIB to another area of the mouth rather than resolve the behavior
8. orthographic surgery to create an open bite and prevent self injurious biting

Question 19

What can drooling be due to

Answer 19

abnormalities in swallowing
difficulties moving saliva to back of thought 
poor mouth closure
jaw instability
tongue thrusting

Question 20

How should drooling be dealt with

Answer 20

techniques designed to improve posture should be implemented
tx should be started with non pharmacological and non surgical methods
there should be careful monitoring for oral complications if surgical or pharmacological tx is carried out

Question 21

If there is bruxism / NCTSL what can be done

Answer 21

construction of splints may be helpful but success dependent on px compliance

Question 22

What can NCTSL be due to

Answer 22

grinding
reflux
medications
drinks

Question 23

What is erosion advice

Answer 23

F mouthwash unless swallowing diffuclites

toothpaste - low brain, acidity, high fluoride, anti-hypersensitivity

brushing delayed after one hour of consuming acidic food and drink

professional application of FV advised

DBA may be of value

reduce or eliminate intake of acidic drinks and fruits or at meal times

chew sugar free gum or eat cheese after acid meal

consider referral

Question 24

How can we help deal w dry mouth

Answer 24

saliva replacements may be helpful
use of sugar free gum and fluids advised
mouth should be examined regularly
fluoride rinses or high fluoride containing TP is advised
referral to appropriate dental specialist may be required

Question 25

What can be done about feeding problems

Answer 25

good OH advised

intensive regime followed to prevent oral disease

low foaming toothpaste

use suction toothbrush can be of benefit

therapy should be carried out to try reduce oral defensiveness

Question 26

What can thickeners used for

Answer 26

dysphagia

prevent aspiration

Question 27

When are tasters used

Answer 27

for those who take nil by mouth

Question 28

What does treatment under LA depend on

Answer 28

ability to cooperate
volume of tx
type of tx - is it realistic
behavioral techniques and px management

Question 29

What are the aims of sedation

Answer 29

include reducing fear and anxiety, augmented pain control, minimizing movement and increasing safety

Question 30

What are adv and disadvantages of sedation

Answer 30

available in primary care/PDS
need for iV access
need to maintain airway - keep breathing
level of understanding necessary
medical status

Question 31

What is the indication for GA

Answer 31

clear inability to cooperate with provision of dental care using other px management techniques including sedation (or contraindication to sue of sedation)

Question 32

What does GA require

Answer 32

systematic assessment - full history and consent

ideally seen by dentist who will perform GA

anesthetist assessment prior to tx session

admission protocol

what tx is possible under GA

someone to look after them post op

Question 33

What are pros of GA

Answer 33

comprehensive care
potentially more controllable environment if medical diseases
opportunity for joint working
aftercare and monitoring - inpatient

Question 34

What are cons of GA

Answer 34

risk of death, brain damage

need support for 24h post op
organization of procedure
complex restorative dental tx not possible
teeth of dubious prognosis removed - reduce risk of future GA
difficulty working environment
no improvement in coping mechanisms - GA pattern/dependent

Question 35

What dose safeguarding involve

Answer 35

spectrum of measures with purpose of preventing harm and promoting welfare as well as protecting individuals from harm

Question 36

What is role of GDP in adult protection

Answer 36

recognize - being able to identify adult at risk
respond - manage acute situation and inform other services as required
record - document and report in detail the info obtained and actions taken

Question 37

If concerns arise or a disclosure is made to the practitioner, what are the following steps that outline the initial management

Answer 37

remain calm and reassure the individual
seek further info
record info given
inform person of next actions